Intersect ENT (XENT) Notes Positive CareFirst BlueCross BlueShield Coverage Determination for PROPEL

August 29, 2016 8:03 AM EDT

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Intersect ENT, Inc. (Nasdaq: XENT) announced that CareFirst BlueCross BlueShield, the regional blues provider for Maryland and the National Capital area, has issued a positive coverage decision for PROPEL® and PROPEL® mini steroid releasing sinus implants for use in patients following endoscopic sinus surgery.

CareFirst Blue Cross Blue Shield is the largest health care insurer in the Mid-Atlantic region, serving 3.2 million members across Maryland, the District of Columbia, and Northern Virginia, including more than 577,000 members in the Federal Employees Health Program (FEP) – the largest FEP enrollment in the nation. CareFirst is nationally recognized as a ‘Best in Blue’ insurer for providing stellar customer service for 16 consecutive years for D.C. FEP members.

“We are thrilled to add CareFirst to the growing list of payors who recognize the clinical and economic value of PROPEL and PROPEL mini in addressing the needs of chronic sinusitis patients,” said Lisa Earnhardt, president and CEO, Intersect ENT. “This decision reflects continued positive momentum in obtaining favorable reimbursement for PROPEL.”

Health Economics Data Demonstrate Payor Affordability of PROPEL

There are multiple published randomized controlled trials and single-arm studies documenting the clinical benefits of PROPEL and PROPEL mini, particularly demonstrating the reduction in need for medical and surgical intervention in both the ethmoid and frontal sinuses.1,2,3 Additional health economic data is now available that further supports payor coverage determinations. A budget impact analysis demonstrating the affordability of the PROPEL implant for payors and self-funded employers published in the Journal of Medical Economics demonstrates the use of PROPEL following endoscopic sinus surgery procedures is expected to have a negligible impact on the healthcare budget of either a commercial payor or self-funded employer with 1.5 million covered beneficiaries.

The budget impact analysis methodology is of significant importance to employers since more than 60 percent of covered workers in the U.S. participate in a health care plan that is completely or partially funded by their employer.4 Chronic sinusitis is one of the top 10 most costly conditions to U.S. employers, with a heavy societal productivity cost of more than $12 billion annually.5

“Today’s health care environment demands solutions that optimize cost effectiveness,” said John A. Rizzo, Ph.D., of the department of Preventive Medicine and department of Economics at Stony Brook University in Stony Brook, New York. “These data show that the upfront cost of PROPEL was offset by savings associated with reduced probability for polyp recurrence, adhesion formation, and their subsequent treatment.”

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